3.1 Models of health belief

1. 3.1 Models of health belief

2. Health Belief Model Key study: Becker (1978) Terminology • perceived seriousness (‘Will it actually kill you?’). • perceived susceptibility (‘Am I likely to get it?’). • costs/benefits analysis. • cues to remind us (external or internal cues). • demographic variables (factors such as gender, culture, age, etc.).

3. Aim • To use the health belief model to explain mothers' adherence for their asthmatic children. Method • A correlation between beliefs reported during interviews and the compliance with self-reported administration of asthma medication.

4. Participants • 111 mothers responsible for administering asthma medication to their children. Design • Correlational design.

5. Procedure • Each mother was interviewed for about 45 minutes. • They were asked questions regarding: • Their perception of their child’s susceptibility to illness and asthma. • How serious asthma is. • How much their child’s asthma interfered with his or her education. • Caused embarrassment. • Interfered with the mother’s activities.

6. Procedure (cont.) • They were also questioned about their faith in doctors and the effectiveness of the medication.

7. Findings • A positive correlation between a mother’s belief about her child’s susceptibility to asthma attacks and compliance to medical regimen was found. • There was also a positive correlation was also between the mother’s perception of the child’s having a serous asthma condition and her administering the medication as prescribed. • Mothers who reported that their child’s asthma interfered with the mother’s activities also complied with the medication.

8. Findings (cont.) • Costs negatively correlated with compliance (e.g. disruption of daily activities, inaccessibility of chemists, the child complaining, and the prescribed schedule). • The demographic variable of marital status and education level correlated with compliance as follows: • Married mothers were more likely to comply. • The greater the mother’s education the more likely she would be to adhere.

9. Conclusion • The health belief model is a useful model to predict and explain different levels of compliance with medical regimens.

10. Locus of control Key study: Rotter (1966) Terminology • Internal locus of control – where a person feels he or she is in control of his or her health and is therefore likely to adopt healthy behaviour. • External locus of control – where a person feels his or her health is controlled by external factors (e.g. fate) and is therefore less likely to adopt a healthy behaviour.

11. Method • Review article. Procedure • Sample – six pieces of research into individual perceptions of ability to control outcomes.

12. Findings • Participants who felt they had control over the situation were more likely to show coping behaviours. Conclusion • Rotter concluded that locus of control would affect many of our behaviours.

13. Self efficacy Key study: Bandura (1977) Terminology • Outcome expectancy – based on previous experiences a person could estimate the likely outcome in any situation. • Efficacy expectation – the belief that a person has that they can successfully do whatever is required to achieve the outcome.

14. Terminology (cont.) • The key factors which affect a person’s efficacy expectation are: • Vicarious experiences – seeing other people do something successfully. • Verbal persuasion – someone telling you that you can do something. • Emotional arousal – too much anxiety can reduce a persons’ self-efficacy. • In addition cognitive appraisal of a situation might also effect expectations of personal efficacy.

15. Aim • To assess the self-efficacy of patients undergoing systematic desensitisation. Method • A controlled quasi-experiment with patients with snake phobias.

16. Participants • 10 snake phobic patients: • who replied to an advertisement in a paper. • 9 females and one male. • aged 19–57 years.

17. Procedure • Pre-test assessment. Each patient was assessed for: • avoidance behaviour towards a boa constrictor. • fear arousal with an oral rating of 1–10. • efficacy expectations (how much they thought they would be able perform different behaviours with snakes).

18. Procedure (cont.) • Systematic desensitisation – a standard desensitisation programme was followed where patients were introduced to a series of events involving snakes and at each stage were taught relaxation. • Post-test assessment. Each patient was again measured on behaviours and belief of self-efficacy in coping.

19. Findings • Higher levels of post-test self-efficacy were found to correlate with higher levels of behaviour with snakes. Conclusion • Desensitisation enhanced self-efficacy levels, which in turn lead to a belief that the participant was able to cope with the phobic stimulus of a snake.

20. Possible Section A Questions • Describe what psychologists have found out about theories of health belief • Describe one piece of research into self-efficacy • Outline the health belief model • Describe factors that influence health beliefs and behaviours • Describe one piece of research into locus of control

21. Possible Section B Questions • Discuss the usefulness of research into theories of health belief

22. 3.2 Health Promotion

23. Media Campaigns Key study: Cowpe (1989) Aim • To test the effectiveness of an advertising campaign. Method • A quasi-experiment where a media campaign was shown in 10 regional television areas from 1976 to 1984.

24. Participants • People living in the chosen television areas.

25. Procedure • The campaigns were shown on television. • There were two 60-second commercials, one called ‘inattendance’ and one called ‘overfilling’. • These showed the initial cause of the fire and the actions required to put it out. • Three areas were shown reminders one year later. • The number of reported chip pan fires was analysed for each area.

26. Findings • The net decline in each area over the twelve-month period of the campaign was between 7% to 25%. • The largest reduction was during the campaign. • ‘Overlap’ areas (areas that received two of the television stations) showed less impact. • The questionnaires showed an increase in the awareness of chip pan fire advertising. • The mention of chip pan fires as a danger in the kitchen also increased in the questionnaires.

27. Conclusions • The advertising proved effective as shown by reduction in chip pan fires. • The behaviour change is seen most during the campaign and reduces as time passes after the end of the campaign. • The viewer is less likely to be influenced by the campaign if overexposed to it, as in the overlap areas.

28. Legislation Key study: Dannenberg et al. (1993) Aim • To review the impact of the passing of a law promoting cycle helmet wearing in children. Method • Natural experiment when a law was passed in Howard County, Maryland, USA.

29. Participants • Children from Howard County, and two control groups from Montgomery County and Baltimore County, all in Maryland, USA. • Aged 9–10 years, 12–13 years and 14–15 years. Design • Independent design with each child naturally falling into one of the three counties.

30. Procedure A questionnaire that asked about: • bicycle use. • helmet ownership. • awareness of law. • sources of information about helmets. • peer pressure.

31. Findings • Helmet ownership was higher amongst cycle owners and highest in younger age groups. • In Howard County (the one with the law), reported usage had increased. • Howard County – 11.4% to 37.5%. • Montgomery County – 8.4% to 12.6%. • Baltimore County – 6.7% to 11.1%.

32. Conclusions • Legislation has more effect than educational campaigns alone. • This study was correlated with an observational study by Cote et al. in 1992, which found similar rates of cycle helmet usage.

33. Fear Arousal Key study: Janis and Feshbeck (1953) Aim • To investigate the consequences on emotions and behaviour of fear appeals in communications. Method • Laboratory experiment, which showed fear-arousing material.

34. Participants • 9th Grade students aged 14.0 to 15.11 years, mean age 15 years. Design • Independent design, with three experimental groups and one control group.

35. Procedure • A questionnaire was given one week before the lecture on health to ascertain dental practices. • A fifteen minute illustrated lecture was presented to each group. • 3 groups had a lecture on dental hygiene and the control group had a lecture on the human eye.

36. Procedure (cont.) • Immediately after the lecture a questionnaire was given asking for emotional reactions to the lecture. • One week later a follow-up questionnaire asked about longer term effects of the lecture.

37. Findings • The amount of knowledge on dental hygiene didn’t differ between the three experimental groups. • The strong fear-appeal lecture was generally seen in a more positive light. • The strong fear-appeal group showed a net increase in conformity to dental hygiene of 8%.

38. Findings (cont.) • The net increase in the moderate fear group was 22%. • The net increase in the minimal fear group was 36%. • The control group showed 0% change.

39. Conclusion • Fear appeals can be helpful in changing behaviours, but it is important that the level of fear appeal is right for each audience.

40. Possible Section A Questions

41. Possible Section B Questions • Discuss the usefulness of research into health promotion

42. 3.3 Adherence to medical advice

43. Reasons for non adherence Key study: Bulpitt and Fletcher (1988) Aim • To review research on adherence in hypertensive patients. Method • Review article of research identifying problems with taking drugs for high blood pressure.

44. Procedure • Research was analysed to identify the physical and psychological effects of drug treatment and the adherence rates of patients.

45. Findings • There are many side effects of taking anti-hypertension medication. • In one study by Curb (1985) 8% of males discontinued treatment because of sexual problems. • Research by the Medical Research Council (1981) found that 15% of patients had withdrawn from taking medication due to side effects.

46. Conclusion • When the costs of taking medication, such as side effects, outweigh the benefits of treating a mainly asymptomatic problem such as hypertension, there is less likelihood of the patient adhering to their treatment.

47. Measuring adherence Key study: Lustman et al. (2000) Aim • To assess the efficacy of the anti-depressant fluoxetine in treating depression by measuring glycemic control. Method • A randomised controlled double-blind study.

48. Participants • 60 Patients with type 1 or type 2 diabetes and diagnosed with depression.

49. Procedure • Patients were randomly assigned to either a fluoxetine or a placebo group. • Patients were assessed for depression using psychometric tests and their adherence to their medical regimen was assessed by measuring their GHb levels, which indicated their glycemic control.

50. Findings • Patients given fluoxetine reported lower levels of depression. • Patients given fluoxetine had lower levels of GHb, which indicated their improved adherence.